Transpedicular vertebral biopsy under O-arm navigation: a technical note

Abstract

Background Despite emerging techniques, sample inadequacy remains the most important factor that necessitates need for repeat biopsy. Transpedicular Biopsy has diagnostic accuracy ranging from 75 to 90% in both computed tomography guided or percutaneous C-arm guided biopsy. Presenting in this article is an add on technique as a modification to enhance quality and quantity of sample obtained using a self designed trocar cannula with computed tomography-based Navigation. Main body We have used transpedicular biopsy technique under C Arm fluoroscopy, previously, where we used a self-designed trocar and cannula in our study of 71 cases & reported an accuracy of 88.7% with no reported complications. This is add on modification of same technique where under 3D navigation, we introduce a pituitary forceps through a correctly positioned cannula. This helps for biopsy of soft lesions/ discal level pathologies. Also, multi-planar adjustment of cannula after initial Stealth O-Arm navigation helps in sampling of different regions of vertebral body by reinsertion of pituitary forceps with simple manipulation of cannula without withdrawal. This minimizes risk of fracturing pedicle. With our technical modification, cannulated drill bit with core opening can be drilled through cannula to retrieve a sample. Our technique has limitations being experience driven and also enabling technology dependent. However, same method can be applied using 2-dimensional fluoroscopy without navigation. Conclusion Our technique of using pituitary forceps through cannula is highly effective in getting adequate representative sample with spectrum ranging from hard sclerotic lesions to soft lesions and discal pathologies. This procedure can be used with traditional 2-dimensional fluoroscopy as well as with 3-dimensional navigated precision.

Postoperative Lumbar Spondylodiscitis Following Transforaminal Endoscopy and Outcomes of Transforaminal Lumbar Interbody Fusion

“…To cover these group of organisms, board spectrum 2nd and 3rd generation cephalosporins are good empirical choice to treat such community acquired infections in general [60]. Computed tomogrpahy-guided biopsy or trocar biopsy is commonly done [47,61,62]. Biopsy along with TELD itself as a management of lumbar infectious primary spondylodiscitis, is an effective treatment method in early cases (76%), and provide higher bacterial diagnostic efficacy (90%) [47].…”

“…POS is treated primarily with immobilization and a combina-tion of antibiotics from 4 weeks to 24 weeks [61][62][63][64][65]. The timeline and best technique for treating POSe are still up for debate.…”

“…Resumption to basic activities and job was assessed in our study and reasonable early return were noted in all patients. Patients with disc space infection progress to spontaneous interbody fusion within a period of 6 to 12 months [61,66]. The conservative treatment should be given for not more than 3-4 weeks because delaying the ambulation and productivity can have long-lasting impact on the patient in various forms of disability, and psychological dysfunction as a burden of cost.…”